ArticleBMC primary care2025
How do people with multimorbidity prioritise healthcare when faced with tighter financial constraints? A national survey with a choice experiment component.
Article in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Financial Toxicity in Diabetes: The State of What We Know.Current diabetes reports · 2025Pooled it
- Mental Health Service use and Expenditures among Medicare Beneficiaries with Depression, Diabetes and Heart Disease after Cost-sharing Parity.Journal of general internal medicine · 2026Article
- Real-World Effectiveness of Dalbavancin in Osteomyelitis Without Implantable Devices: A Retrospective Monocentric Study.Antibiotics (Basel, Switzerland) · 2026Article
- Understanding challenges in healthcare access: qualitative insights from healthcare providers and people living in socio-economically vulnerable circumstances.International journal for equity in health · 2025Article
- Machine learning based predictive model of the risk of Tourette syndrome with SHAP value interpretation: a retrospective observational study.Scientific reports · 2025Observational
- Out-of-pocket prescription medicine expenditure amongst community-dwelling adults: Findings from the Irish longitudinal study on ageing (TILDA) in 2016.Exploratory research in clinical and social pharmacy · 2025Article
- [Digital health and its impacts on the access of minority groups to primary care: a systematic reviewLa salud digital y su impacto en el acceso a la atención primaria de salud en grupos minoritarios: revisión sistemática].Revista panamericana de salud publica = Pan American journal of public health · 2025Article
- Association between catastrophic health expenditure and mortality in older people in 11 European health systems: a longitudinal analysis between 2006 and 2020.BMJ public health · 2025Article
- Patient and public involvement in clinical trials to improve outcomes for adults with multimorbidity in primary care and community settings: A systematic review protocol.Journal of multimorbidity and comorbidityArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundPeople with multimorbidity (i.e., two or more chronic conditions) experience increased out-of-pocket healthcare costs and are vulnerable to cost-related non-adherence to recommended treatment. The aim of this study was to understand how people with multimorbidity prioritise different healthcare services when faced with tighter budget constraints and how they experience cost-related non-adherence.
methodsA national cross-sectional online survey incorporating a choice experiment was conducted. Participants were adults aged 40 years or over with at least one chronic condition, recruited in Ireland (December 2021 to March 2022). The survey included questions about real-life experiences of cost-related non-adherence and financial burden. The choice experiment element involved participants identifying how they would prioritise their real-world healthcare utilisation if their monthly personal healthcare budget was reduced by 25%.
resultsAmong the 962 participants, 64.9% (n = 624) had multimorbidity. Over one third (34.5%, n = 332) of participants reported cost-related non-adherence in the previous 12 months, which included not attending a healthcare appointment and/or not accessing medication. Similar findings on prioritisation were observed on the choice task. When presented with the hypothetical tighter budget constraint, participants reduced expenditure on 'other healthcare (hospital visits, specialist doctors, etc.)' by the greatest percentage (50.2%) and medicines by the lowest percentage (24.8%). Participants with multimorbidity tended to have a condition they prioritised over others. On average, they reduced expenditure for their top-priority condition by 71% less than would be expected if all conditions were valued equally, while they reduced expenditure for their least prioritised condition by 60% more than would be expected. Independence, symptom control and staying alive were rated as the most important influencing factors when making prioritisation decisions (median score = 5 out of 5).
conclusionWhen faced with tighter financial constraints, people with multimorbidity tended to have a condition they prioritised over others. Participants were also more likely to prioritise medicines over other aspects of healthcare. Researchers, policymakers and clinicians should take greater consideration of the different ways people respond to tighter financial constraints. This could involve reducing the payment barriers to accessing care or clinicians discussing healthcare costs and coverage with patients as part of cost-of-care conversations.
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